STRESS MANAGEMENT

Stress is a well-known and identified problem within the nursing

profession. Stress occurs when one is faced with events or encounters that they
perceive as an endangerment to their physical or psychological well being.
Additionally stress levels will increase when controllability and predictability in a
situation decrease. (McGowan, 2001)
Stress is intrinsic to nursing and a highly demanding job with poor support,
rapidly changing circumstances, shortage of resources and staff, and dealing
with death and dying all contribute (Chang et al., 2005). Nursing is emotionally
demanding and this interactive stress contributes to the daily stress of nurses
(Mann and Cowburn, 2005). Environmental factors compound these intrinsic
factors and these include difficult patients and their families, relationships with
physicians and low institutional commitment to nursing (Chang et al., 2005).
Stress has been identified as a 20th century disease and has been viewed
as a complex and dynamic transaction between individuals and their
environments (Kelly & Evans, 2004). Stressors can be broadly defined as
situations or events that have the potential to affect health outcomes. Stress can
be regarded as a psychological threat, in which the individual perceives a
situation as a potential threat (Day & Livingstone 2004).
A student may face many challenges and stressors. However, nursing
students are likely to experience even more stress than others enrolled in other
programs. A study comparing the stress levels of various professional students
found that nursing students experience higher levels of stress than medical,
social work and pharmacy students.(Beck, et al.,1997) Even more poignant,
another study showed that “one third” of nursing students experience stress
severe enough to induce mental health problems such as anxiety and
depression. (Pryjmachuk, 2004)
In addition to contending with examinations, grades, long hours of
studying, work, family and other personal commitments you are also faced with
the challenges of clinical practice. Clinical practice has been identified as one of
the most anxiety producing components in nursing programs. Lack of
experience, fear of making mistakes, difficult patients, discomfort at being
evaluated by faculty members, worrying about giving patients the wrong
information or medication and concern about possibly harming a patient are just
a few of the stressors for the beginning student nurse. (Sharif & Masoumi, 2005).
Stress among nursing students is a paramount concern of nursing
educators because high stress levels often lead to decreased learning and higher
drop-out rates. Moderate to high levels of stress have been found to have a
negative effect on learning and impaired judgment. (Patel, Sudduth & Jakopac
2005)
College students are prone to stress due to the transitional nature of
college life. High levels of stress are believed to affect students' health and
academic functions. If the stress is not dealt with effectively, feelings of
loneliness, nervousness, sleeplessness and worrying may result. Effective
coping strategies facilitate the return to a balanced state, reducing the negative
effects of stress. (Seyedfatemi N., Tafreshi M. & Hagani H., 2007)
Nursing students have the same academic stressors as other college
students, such as midterm and final examinations, research papers and other
assignments (Kelly & Evans, 2004). In addition, nursing students experience a
clinical component, which is highly stressful. Students have a large amount of
preparatory work before their clinical assignments. They often must travel long
distances to clinical sites and use highly technical equipment (Mahat, 1998) In
addition, they must perform procedures that can cause serious harm to their
patients, thus enhancing their fear of making mistakes. (Shriver, 2000)
 In college and university students, some stress is motivating, whereas too
high a level interferes with teaching (Kelly & Evans, 2004). Excessive stress can
be harmful to a student's academic performance and students who perceive their
stress levels as very high may often become depressed. This depression can
lead to other mental health problems, such as excessive drinking or
indiscriminate use of other substances (Robin & Walton, 2002). Thus, academic
stressors cover the whole area of learning and achieving, as well as adjusting to
a new environment, in which a great deal of content must be assimilated in a
seemingly inadequate period of time (Kariv & Heiman, 2005). Moreover,
excessive stress may lead a student to drop out of college (Shields N. 2001).
Student perception of high stress levels can lead to poor academic
performance, depression, attrition and serious health problems. Methods to
reduce student stress often include effective time management, social support,
positive reappraisal, and engagement in leisure pursuits (Misra R, McKean M,
2000).
The cause of stress for nurses has found to be related to the nature of the
profession. Included in these stressors are an intense work environment with
extended work hours, weekends, night and holidays. According to Ruggiero
(2003) stress could be related to variables of shift work, which is both physically
and mentally taxing. This study also found varying degrees of depression in
nurses ranging from mild to severe. Finally this study revealed that nurses were
indifferent and disconnected to the job by feeling neither satisfied or unsatisfied
with the work. Results such as these expose how large a problem stress is for
the profession of nursing.
Factors of the intense emotional support that is needed for the patient and
family is yet another burden of stress placed on nurse. In addition, exposures to
pain, suffering and traumatic life events that the nurse experience on a daily
basis can contribute to stress (Cohen-Katz, Capuano, Baker, & Shapiro, 2005).
These concerns can lead to emotional exhaustion for nurses.
Virtually everyone experiences stress. However, in a 2001 survey
conducted by the American Nurses Association, it was reported that 70.5% of
nurses cited the acute and chronic effects of stress and overwork among their
top three health and safety concerns and that 75.8% of surveyed nurses report
that unsafe working conditions do, in fact, interfere with their ability to deliver
quality care. In a meta analysis of workplace stress in nursing, several major
themes were identified as sources of workplace stress for nurses. These were:
• Workload/inadequate staff cover/time pressure
• Relationship with other clinical staff
• Leadership and management style/poor locus of control/poor group
cohesion/lack of adequate supervisory support
• Coping with emotional needs of patients and their families/poor patient
diagnosis/death and dying
The individual may deal with stress through several methods, including
removing the stressor through manipulating the environment, developing specific
responses to help deal with the stressor or seeking diversion from the stressor
(Robin & Walton, 2002).
Nursing is a stressful program to study. Implementing techniques to cope
with stress in a nursing program has an effect on retention and performance. It
has been shown that nursing students perform with less anxiety when using
stress coping techniques such as massage. Increasing nurses' knowledge about
complementary techniques supports retention of nurses in academic and
professional fields. An effective nursing program provides ongoing stress
management workshops during the academic year.
Therefore, this seminar is conducted to create awareness among nursing
students to manage their stress. Furthermore, nursing student will learn ways on
how to manage stress practically.
References:

Books:

Chang, E.M., Hancock, K.M., Johnson, A., Daly, J., Jackson, D., (2005). Role
stress in nurses: review of related factors and strategies for moving forward.
Nurs. Health Sci. 7, 57–65.

Mann, S., Cowburn, J., 2005. Emotional labour and stress within mental health
nursing. J. Psychiatry. Mental Health Nurs. 12,154–162.

Electronic Sources:

American Nurses Association (2001). Holistic Stress Management for Nurses

www.ahna.org
Last retrieved: January 1, 2011

Beck, et al.,(1997), Pryjmachuk, (2004), Sharif & Masoumi (2005). Stress

Management for Nursing Students
www.ahna.org (American Holistic Nursing Association)
Last retrieved: December 28, 2010

Cohen-Katz, J., Capuano, T., Baker, D. M., & Shapiro, S. (2005). The effects of
mindfulness-based stress reduction on nurse stress and burnout, part II
Holistic Nursing Practice, 26-35.
Retrieved September 27, 2006, from Ovid data base

Day A.L., Livingstone H.A (2004). Gender differences in perceptions of stressors

and utilization of social support among university students. Canadian Journal
of Behavioral Science, 35(2):73-83.
www.biomedcentral.com
Last retrieved: December 28, 2010

Evans W., Kelly B.(2004): Pre-registration diploma student nurse stress and
coping measures. Nurse Education Today, 24(6):473-482.
www.biomedcentral.com
Last retrieved: December 28, 2010

Kariv D, Heiman T (2005) Task-oriented versus emotion-oriented coping

strategies: the case of college students. College Student Journal, 39(1):72-84.
www.biomedcentral.com
Last retrieved: December 28, 2010

Mahat G (1998) Stress and coping: junior baccalaureate nursing students in

clinical settings. Nursing Forum, 33(1):11-19.
www.biomedcentral.com
Last retrieved: December 28, 2010

McGowan, B. (2001). Self-reported stress and it’s effects on nurses. Nursing

Standard, 15(42), 33-38.
Retrieved September 28, 2006, from Ovid data base

Misra R, McKean M (2000). College students' academic stress and its relation to
their anxiety, time management, and leisure satisfaction. American Journal of
Health Studies. 16(1):41-51
www.biomedcentral.com
 Last retrieved: December 28, 2010

Patel S., Sudduth A. & Jakopac K. (2005). Self-Reported Life Stressors Among
Students in Their First Nursing Course. 16th International Nursing Research
Congress.
stti.confex.com
Last retrieved: December 29, 2010

Robin & Walton L (2002). A Comparison of Perceived Stress Levels and Coping
Styles of Junior and Senior Students in Nursing and Social Work Programs.
www.biomedcentral.com
Last retrieved: December 28, 2010

Ruggiero, J. S. (2003). Health, work variables, and job satisfaction among

nurses. JONA, 35(5), 254-263.
Retrieved October 3, 2006, from Ovid data base

Seyedfatemi N., Tafreshi M. & Hagani H. (2007). Experienced stressors and

coping strategies among Iranian nursing students
www.biomedcentral.com
Last retrieved: December 28, 2010

Shields N. (2001) Stress, active coping, and academic performance among

persisting and nonpersisting students. Journal of Applied Biobehavioral
Research, 6(2):65-81
www.biomedcentral.com
Last retrieved: December 28, 2010

Shriver C.B., Scott-Stiles A (2000). Health habits of nursing versus non-nursing

students: a longitudinal study. Journal of Nursing Education. 39(7):308-314.
www.biomedcentral.com
Last retrieved: December 28, 2010
Identification of the Problem

What are the different factors that cause stress to a nurse or student nurse
and how they will be able to manage it?

Seminar Objectives:

At the end of the Seminar, the participants will be able to:

1. Define stress and stress management.

2. Identify factors that may contribute to stress
3. Identify different activities to lessen stress.
4. Perform different relaxation exercises.
5. Apply learning that they have acquired during the seminar workshop.

Resource Person

The resource speaker for the Seminar on Stress Management is Henrietta

Española, MD, FPPA (Fellow, Philippine Psychiatric Association).

Target Population

• St. Paul University Iloilo Nursing Students, BSN IV - Regular Track (Angeli
Beati Domini 2011)